TNF-alpha releasing capacity of the whole blood drops after open total splenectomy, but increases after partial/subtotal or minimally invasive splenectomy

Background The mechanisms that induce immunodeficiency after splenectomy remain unknown. The aim of this study was to measure the cytokine releasing capacity of the whole blood as an expression of the innate immunity after total (TS) and subtotal/partial splenectomy (S/PS) in order to assess the impact of splenectomy on the individual cytokine reactivity. Methods We prospectively collected blood before (D0) and at multiple time points after splenectomy (7 days - D7, 30 days - D30, 90 days - D90, 180 days - D180, and 360 days - D360) and measured the cytokines releasing capacity of IL-6, TNF-alpha and IL-10 from whole blood under LPS stimulation which we normalized to the monocytes number. Results When analyzing all splenectomies at D0, D7 and D30, normalized Delta TNF-alpha significantly dropped after splenectomy (p = .0038) and normalized Delta IL-6 and Delta IL-10 did not significantly change. More specifically, normalized Delta TNF-alpha dropped after TS (p = .0568) and significantly increased after S/PS (p = .0388). Open surgery induced a decrease in normalized Delta TNF-alpha (p = .0970), whereas minimally invasive (MI) surgery significantly increased the normalized Delta TNF-alpha releasing capacity (p = .0178). The cytokine levels were heterogenous between pathologies at D0, and Delta IL-6 dropped mainly in cirrhotic patients after splenectomy (all underwent TS), Delta TNF-alpha dropped in immune thrombocytopenic purpura patients (all underwent TS), but increased in spherocytosis (91% underwent S/PS) after splenectomy. Conclusions Splenectomy induces a decrease of the pro-inflammatory cytokine TNF-alpha and if splenic parenchyma is spared and the surgery is performed MI, this change is hindered.

Automated summary

The study found that after splenectomy, the releasing capacity of TNF-alpha in whole blood significantly decreased, while the capacities of IL-6 and IL-10 did not show significant changes. The impact of total splenectomy (TS) and subtotal/partial splenectomy (S/PS) on cytokine releasing capacities differed, with open surgery leading to a decrease in TNF-alpha releasing capacity and minimally invasive surgery significantly increasing it.